Medicare Rebates

How do Medicare Rebates work?

You can have psychology appointments without a Medicare rebate at any time, but with no rebates you would be responsible to pay fees. With a Medicare rebate there still may be a gap to pay, unless the psychologist has agreed to 'bulk-bill' your services in which case there would be no gap to pay.

To be able to access any Medicare rebates for psychology services you need to have a valid referral from a General Practitioner (GP), or a Psychiatrist, or a Paediatrician. A referral from a GP must include a Mental Health Care Plan or a Mental Health Treatment Plan that is accepted by Medicare. Once you have a referral, you can receive Medicare rebates for up to 10 psychology sessions in a calendar year. A first referral will usually cover 6 sessions. Once the first 6 sessions are completed, or sooner if necessary, the psychologist will write to the referring GP or the GP's practice with a summary of how things have been going. If the GP sees you and thinks more sessions are appropriate, he may then refer you for up to a further 4 sessions of psychology with Medicare rebates.

You do not need to use up all sessions in a calendar year. For example, if you received a first referral in May 2017 and only used 3 Medicare rebates in 2017, you could continue to see the psychologist for a further 3 sessions in early 2018 before you would need another referral. However, you can not accumulate sessions, so you would still only be eligible for a maximum of 10 sessions with rebates in 2018. Your GP would need to approve further sessions beyond the initial 3 sessions.

Sometimes a GP may make a referral of a different type called a Team Care Arrangement (TCA). A Team Care Arrangement comes with a lower rebate so there may be a larger gap to pay and the number of psychology sessions with rebates may be limited to 3 in a calendar year. Bulk-billing of Team Care Arrangements is likely to be not viable from the psychologist's point of view unless you only need short sessions. If your GP has issued a Team Care Arrangement and no Mental Health Care Plan, it would be best to discuss this with the psychologist before making your first appointment.

Medicare rebates are only there for the face-to-face component of an appointment. If you request services the go beyond what Medicare covers, you may be required to pay additional fees. This may apply to letters and reports to third parties, longer phone calls, and photocopying. Medicare is only there for health funding so if you request something that goes beyond the scope of health funding, you may be asked to pay separately for that service.